Provider Demographics
NPI:1336627439
Name:RUNYAN, CRAIG PHILLIP (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:PHILLIP
Last Name:RUNYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2915
Mailing Address - Country:US
Mailing Address - Phone:641-424-5522
Mailing Address - Fax:641-421-9457
Practice Address - Street 1:875 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2915
Practice Address - Country:US
Practice Address - Phone:641-424-5522
Practice Address - Fax:641-421-9457
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist